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TBI Recovery Hampered By Inadequate Health Insurance Coverage

On Eve Of Capitol Hill Event, Group Urges Expanded Coverage Of Services For Communication Needs

(Rockville, MD -
March 15, 2011)

The American Speech-Language-Hearing Association (ASHA) today called upon health insurers and U.S. policymakers to strengthen health insurance coverage of services that help those who have trouble communicating due to traumatic brain injuries (TBIs) and other causes.

ASHA issued its call on the eve of "2011 Brain Injury Awareness Day On Capitol Hill," an event the organization participates in annually. It also did so against the backdrop of two powerful accounts that clearly demonstrate not only how important the ability to communicate is to daily living, but also how critical it is for help to be available when a person has trouble communicating: the shooting of Rep. Gabrielle Giffords; and, the Academy Award winning "The King's Speech,"a film that depicts England's King George VI's struggle with stuttering.

"The ASHA membership has long cited the inadequacy of insurance coverage as the major hindrance in their rehabilitation work with TBI patients—not the injuries themselves, which can be surmounted with the right kind and amount of care," ASHA 2011 President Paul R. Rao, Ph.D. CCC-SLP says.

For military, an egregious example of inadequate coverage lies in what is offered by TriCare, the health insurance plan for active military and retirees. TriCare refuses to cover cognitive rehabilitation services. This is in stark contrast to the Department of Veterans Affairs, a leader in such rehabilitation programs.

TBIs among soldiers returning from Iraq and Afghanistan have been well publicized. However, far less known is the extent of TBIs among the U.S. civilian population. Nearly 2 million Americans suffer TBIs annually, an incidence rate twice that of breast cancer and AIDS combined, two widely publicized conditions that are focal points of concerted advocacy.

"Unfortunately, the health insurance coverage that is available to the average person with a TBI is very limited," Dr. Rao notes. "Consequently, millions of Americans are not only kept from recovering, but also forced to endure the frustration of knowing they could if there was better coverage. This is completely unacceptable."

The human stories behind the statistics are rife with difficult struggles that drain patients and caregivers of their resources. Yvonne Hoffman, a participant in Civilian TBI: The Other Story, a 2007 ASHA public awareness campaign, reported that "controlled panic would be a good way to describe how I feel at times" as she struggled to recover from a concussion she suffered when she fell walking her dog. "It could take me more than two years to get back to where I was physically before the accident," Hoffman said. "However, I might not be able to get all of the way back. My treatment sessions have ended and I'm so scared."

Speaking of her life after a TBI caused by a car accident, Carolyn McCormack said that "to add insult to injury, I found out my insurance company wouldn't cover this cognitive rehab therapy that I so desperately needed."

According to ASHA's Rao, not much has changed since Hoffman and McCormack shared their experiences, and he expresses serious concern that the new health care reform law may just bring "more of the same."

"Implementation models are being looked at by the Department of Health and Human Services that do not include the services of speech-language pathologists and audiologists." Dr. Rao explains. "We have asked for reconsideration of this, but no word of that has been forthcoming."

Dr. Rao adds: "Many Americans are just like Rep. Giffords and George VI in that they are struggling with communication because of a TBI or some other cause. Unlike them, though, they can't access the services they need because their health insurance is so inadequate.

"Surely we should be inspired by the likes of Rep. Giffords and George VI. Even more than that, however, we should take steps to change our system of health insurance so that people can receive the services they need and deserve for their communication health."

About the American Speech-Language-Hearing AssociationASHA is the national professional, scientific, and credentialing association for more than 140,000 audiologists, speech-language pathologists, and speech, language, and hearing scientists. Audiologists specialize in preventing and assessing hearing and balance disorders as well as providing audiologic treatment including hearing aids. Speech-language pathologists identify, assess, and treat speech and language problems including swallowing disorders.